Transcript PFFD Van Nes Rotationplasty vs. Transfemoral Amputation (Kaiser

Proximal Femoral Focal Deficiency Treatment:
Effects of Van Nes Rotationplasty vs. Transfemoral Amputation on Gait and Energy Efficiency
Megan Kaiser, Student PT
Introduction
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http://www.wheelessonline.com/ortho/proximal_focal_femoral_deficiency
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Definition: proximal femur and acetabulum fail to
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form correctly during development
Shortening of the lower limb
Classified using Aitken’s System
• Class A or B: femoral head still intact; limb
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lengthening procedure
• Class C or D: femoral head is absent; Van Nes
rotationplasty or transfemoral amputation1
• Van Nes rotationplasty: lower limb is
rotated and ankle joint is used to
function as knee joint, prosthesis is
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fitted to new “knee joint”
Individualized treatment plan
References
1. Westberry D, Davids J. Proximal focal femoral deficiency (PFFD):
management options and controversies. Hip International.
2009;19(1):S18-S25. Accessed November 12, 2013.
2. Rabuffetti M, Recalcati M, Ferrarin M. Trans-femoral and amputee gait:
socket-pelvis constraints and compensation strategies. Prosthet Orthot
Int. 2005;29:183-192. Accessed November 11, 2013.
3. Nolan L, Wit A, Dudziñski K, Lees A, Lake M, Wychowañski M.
Adjustments in gait symmetry with walking speed in trans-femoral and
trans-tibial amputees. Gait & Posture. April 2003;17(2):142. Available
from: SPORTDiscus, Ipswich, MA. Accessed November 12, 2013.
4. Sjödahl C, Jarnlo G-B, Söderberg B, Persson BM. Kinematic and kinetic
gait analysis in the sagittal plane of trans-femoral amputees before and
after special gait re-education. Prosthet Orthot Int. 2002;26:101-112.
Accessed November 11, 2013.
5. Jeans K, Browne R, Karol L. Effect of amputation level on energy
expenditure during overground walking by children with an
amputation. The Journal Of Bone And Joint Surgery. American
Volume [serial online]. January 5, 2011;93(1):49-56. Available from:
MEDLINE, Ipswich, MA. Accessed November 13, 2013.
6. Ackman J, Altiok H, Flanagan A, Peer M, Graf A, Krzak J, Hassani S,
Eastwood D, Harris GF. Long term follow-up of Van Nes rotationplasty in
patients with congenital proximal femoral focal deficiency. Bone Joint J.
2013;95-B:192-8. Accessed November 10, 2013.
Conclusion
Transfemoral Amputation
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Briana Ulanowski, Student PT
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Performed if femur is < 50% of contralateral
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femur
Effects on gait
• Decreased hip extension on prosthesis side
causing increased pelvic tilt during heel strike
of intact limb due to stump-socket
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interference
• Greater stress on intact limb due to loss of
proprioception and decreased balance on
prosthetic limb; including transtibial
amputations3
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• Increased vaulting on intact limb
• Muscle weakness (hip abductors, flexors, and
extensors)4 creating an increase in gait
asymmetry
Effects on energy efficiency
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• Amputation VO2 cost was 151% of normal
• Self-selected walking velocity was 80% of
normal5
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http://blog.poacfl.com/tag/orlando-prosthetics/page/12/
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Van Nes Rotationplasty
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Performed if ipsilateral foot is at level of contralateral knee1
Effects on gait
• Decreased hip extension on prosthesis side resulting in
increased anterior pelvic tilt due to limited ROM and
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strength
• Decreased hip flexion power6
• Asymmetrical weight-bearing6
Effects on energy efficiency
• Transtibial amputation walk as fast as their normal peers
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without increasing energy cost
Transfemoral amputation
• Increased anterior pelvic tilt to control balance by
shifting COG2,6
• Decreased hip ROM due to extrinsic factors2
• After gait training there was decreased LBP, increased
muscle strength, and more symmetrical gait2,4
• Vaulting on intact limb was decreased after gait
training, but increased at follow-up; suggests
repeated training may reduce vaulting3
Van Nes rotationplasty
• Decreased hip ROM due to intrinsic factors6
Both transfemoral amputation and Van Nes rotationplasty
• Amputation should be done at the lowest possible
level for energy conservation5
• Asymmetrical weight bearing/shifting with
anticipatory movement6
• Decreased hip strength in both types and ankle
strength decreased only in Van Nes rotationplasty4,6
Reflection
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Further Research should include:
• Association between postural instability and
musculoskeletal impairments
• Effects on low-back pain
• Comparison of transfemoral and Van Nes
rotationplasty amputations
Proposed treatment plan:
• Gait training
• Muscle strengthening
• Balance and Proprioception
http://stevenbattlescancer.blogspot.com/2011/08/prosthetic-part-2.html
http://www.bellarmine.edu/about/seal/
http://stevenbattlescancer.blogspot.com/2011/08/prosthetic-part-2.html